Functional Outcome Study of Mega-Endoprosthetic Reconstruction in Limbs With Bone Tumour Surgery
|
|
- Frank Dixon
- 5 years ago
- Views:
Transcription
1 192 Original Article Functional Outcome Study of Mega-Endoprosthetic Reconstruction in Limbs With Bone Tumour Surgery Peh Khee Tan, 1 MBBS, MRCS (Edin), MMed (Orthop), Mann Hong Tan, 1 MBBS, FRCS (Edin and Glas), FAMS Abstract Introduction: Amputation is no longer the sole contribution of the orthopaedic surgeon to the management of primary bone tumours. Improvements in the design of endoprostheses and surgical reconstructive techniques have combined with advances in chemotherapeutic regimens to result in surgical procedures for salvaging limbs with aggressive sarcomas and in limb reconstruction. This has made limb salvage a viable alternative to amputation in many cases. The aim of this study was to evaluate functional outcome and complications of patients with primary bone tumours who were treated with re-section and mega-endoprosthetic replacement. Materials and Methods: Nineteen patients with bone tumours were retrospectively reviewed. These patients had wide local re-section and mega-endoprosthetic reconstruction performed between 1999 and 2006 in a tertiary hospital. Functional evaluation was performed based on the Musculoskeletal Tumour Society (MSTS) scoring system, with numerical values from 0 to 5 points assigned for each of the following 6 categories: pain, function, emotional acceptance, use of supports, walking ability and gait. These values were added, and the functional score was presented as a percentage of the maximum possible score. Complications were also analysed. Results: The final mean functional score was 78.3% ± 16.6%. Eight patients had complications related to surgery, including infection and subluxation of hip implant. Six patients had infection, while 2 had subluxation of hip implants. Infection was a common complication in our study. None had implant breakage, loosening or fracture. We found no statistical difference in the functional outcome between upper limb and lower limb procedures, and between hip and knee procedures. T-test also showed no evidence of gender differences in functional outcome. Kaplan-Meier survival analysis revealed the mean survival duration of megaprosthesis to be 75.6 months. Conclusion: Mega-endoprosthetic reconstruction in limb salvage provides good functional outcome in patients with bone tumours. The early results from patients treated with megaendoprosthesis have been encouraging. Ann Acad Med Singapore 2009;38:192-6 Key words: Limb salvage, Megaprosthesis Introduction Limb salvage surgery is a widely accepted alternative to amputation in patients with primary bone tumours. The success of limb salvage is the result of the combined understanding of the biology and staging of tumours, improvements in reconstructive techniques, and the development of effective adjuvant chemotherapy for the primary tumours and bone sarcomas. Metallic implants fixed with methylmethacrylate cement are now well established in the management of pathological fractures secondary to metastatic carcinoma. 1,2 In such patients with metastatic disease, the treatment aims at improving the quality of short life expectancy that remains, and the demands placed on the prosthetic implant and the length of time it is expected to function satisfactorily are also limited. On the other hand, patients requiring resection of primary bone tumours are often young and are expected to live with the prosthesis for many years. A substantial amount of healthy bone may need to be resected to ensure a safe margin, leaving the remnant bone segment a little short for the secure fixation of a megaendoprosthesis. This study aims to evaluate the functional outcome of 19 patients with primary malignant or aggressive benign bone tumours that necessitated large bone segment resection and mega-endoprosthetic replacement in the Musculoskeletal 1 Department of Orthopaedic Surgery, Singapore General Hospital, Singapore Address for Correspondence: Dr Tan Peh Khee, Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore
2 193 Tumour Service of a Singapore hospital between 1999 and Materials and Methods Nineteen patients diagnosed with primary malignant or aggressive benign bone tumours underwent definitive wide local resection and mega-endoprosthetic reconstruction and were evaluated with regards to their functional outcome using the Musculoskeletal Tumour Society (MSTS) scoring system (Table 1). Numerical values from 0 to 5 points were assigned for each of the following 6 categories: pain, function, emotional acceptance, use of supports, walking ability and gait. These values were added, and the functional score was presented as a percentage of the maximum possible score. The results were graded according to the following scale: Excellent 75% to 100%; good 70% to 74%; moderate 60% to 69%; fair 50% to 59% and poor <50%. Stryker Modular Resection System and Howedine Modular Resection Systems were used in some of the surgical operations. Complications related to surgery such as infection, implant breakdown, aseptic loosening, dislocation, skin necrosis and fractures were evaluated. Local recurrences and Table 1. Musculoskeletal Tumour Society Functional Outcome Score Patient Musculoskeletal Tumour Society no. Functional score (%) Mean Final Functional Score 78.3 ± 16.6 metastases were also recorded. A complication was defined as early when it occurred within 6 months after the primary surgery and as late when it occurred more than 6 months after the primary surgery. The management of complications, such as revision surgery (removal of endoprosthesis, arthrodesis, amputation) was also recorded. Furthermore, complications related to the disease itself, such as metastases, and any treatment of such complications, were recorded. Results Of these 19 patients, 10 were diagnosed with osteosarcoma (OS), 3 had giant cell tumour (GCT), 2 had aneurysmal bone cysts (ABC), 3 had chondrosarcoma (CS) and 1 had Ewing s sarcoma (ES). All underwent wide local resection with mega-endoprosthetic reconstruction. The surgery was performed between 1999 and The MSTS functional scores were calculated for these 19 patients. The mean final functional score was 78.3% ± 16.6%. In our study, we achieved good to excellent results with our mean functional score of 78.3%. Statistical analysis was performed on the MSTS functional scores using the SPSS software t-test. Upper limb procedures have a higher mean functional score compared with lower limb procedures (27.0 vs 23.1). Using the independent Table 2. Breakdown of Procedures into Upper and Lower Limb Procedures Upper Limb 2 (1 low-grade chondrosarcoma of proximal humerus, 1 osteosarcoma of proximal humerus) Lower Limb 17 patients: (Knee procedures: 13, Hip procedures: 4 ) 7 distal femur osteosarcoma 3 proximal tibia osteosarcoma 2 proximal tibia chondrosarcoma 2 proximal femur aneurismal bone cyst 1 proximal tibia GCT 1 proximal femur clear cell chondrosarcoma 1 proximal femur Ewing s sarcoma GCT: giant cell tumour Table 3. Complication Rate of the Patients in Our Study Complication No. % Early infection Late infection Infection requiring revision Subluxation of implant Aseptic loosening 0 0 Implant breakage 0 0 Common peroneal nerve palsy Periprosthetic fracture 0 0 March 2009, Vol. 38 No. 3
3 194 Table 4. Comparison of Results of Our Study and That of Other Studies No of patients Results (%) Hiroyuki et al Schindler et al Wilkins et al Miller et al Our Study Table 5. Comparison of Infection Rate of Our Study With That of Other Studies Study No. of patients Infection (%) Hiroyuki Cool et al Schiller et al Our Study t-test, we found no statistically significant difference between the 2 groups (t =7.38, P = 0.118). This finding may be influenced by the small sample size and the uneven subgroup sizes (Upper limb procedure no = 2, lower limb procedure no = 17). Retrospective examination revealed that the statistical power of the test was low (power = 0.343). In addition, comparing hip and knee procedures using the t-test found no significant statistical difference between the 2 groups (t = 6.97, P = 0.125), even though hip procedures were found to have a higher mean functional score (25.3 vs 23.4). In addition, we found no evidence of gender difference in terms of functional score (t = 0.227, P >0.05, n = 19). Kaplan-Meier survival analysis was performed to examine the duration (months) of disease-free survival of the megaprosthesis. The megaprosthesis was considered a failure when revision surgery had to be performed for any reason. We found the mean survival time to be 75.6 months with standard errors (SE) of 6.5 months, and a 95% confidence interval between 62.8 and 88.3 months (refer to Figure 4 which shows the Kaplan-Meier Curve). Two patients had metastastatic disease on follow-up: 1 had metastasis to the lung, while the other had metastasis to the cervical spine. The patient with pulmonary metastasis had osteosarcoma of the proximal humerus, while the patient with spinal metastasis had distal femur osteosarcoma. Two other patients had recurrence of the primary bone disease. One of them had recurrence of GCT, while the other had recurrence of osteosarcoma. Both required further surgery for the recurrence. The age of the patients ranged from 13 to 63 years (mean, 33.26). Seventeen patients underwent lower limb surgical procedures while 2 underwent upper limb procedures (Table 2). Among the 19 patients, 8 had complications related to surgery (Table 3). Three had early infection such as cellulitis which required intravenous antibiotics treatment. Three had late infections that required intravenous antibiotics treatment. Of the 3 who had late infections, 1 required surgical debridement. This patient had a left proximal femur aneurysmal bone cyst and underwent wide resection with proximal femoral reconstruction with bipolar implant using the Howedine Modular Resection System. Nine months post-operation, he was walking with walking aids with minimal pain. However 3 years post-operation, he presented with infected ulcers over the left gluteal region with subluxation of hip implant, requiring wound debridement and revision of hip mega-prosthesis with pedicled gluteal flap coverage. Two patients had subluxation of the hip endoprosthesis. One required revision surgery as it was infected as well as subluxed as described above. The other patient was able to ambulate with crutches. None had implant loosening, breakage or periprosthetic fractures. One had foot drop secondary to common peroneal palsy. This patient had proximal tibia osteosarcoma. Six months post-surgery, he was able to walk with a single crutch and coped well with his foot drop. Understandably, a tendency toward higher functional scores was noted in patients who did not have complications compared with those who did. For example, the patients with infection, hip implant subluxation and common peroneal nerve palsy were found to have a lower functional outcome score. The common peroneal nerve palsy rate was 5.3%. Discussion The first reported case of a prosthetic implant for tumour was for a recurrent GCT of the proximal femur. This was replaced with a 25-cm long Vitallium mould of the upper end of the femur. After the operation, the active range of motion at the hip joint was approximately three quarters of the normal, although unfortunately, this patient died 20 months later from cardiac failure. 3 Custom built protheses have been used to replace the femur, the hip joint, part of the pelvis, the knee joint, the humerus and shoulder joint, and parts of the ulna and radius. These are the most common predilection sites of primary bone tumours. The use of limb-preserving mega-endoprostheses should be considered in patients with malignant bone tumours such as CSs or osteosarcomas. Those with benign and aggressive but destructive bone lesions unsuitable for simple bone grafting such as in Enneking stage 3 GCTs are suitable for mega-endoprosthetic reconstruction in replacing resected bone segments. Megaprosthetic reconstruction has many advantages. It provides immediate stability which allows earlier
4 195 Fig. 1. Showing resected bone ends of distal femur and proximal tibia. Fig. 2. Showing trial components of megaprosthetic implants. Fig. 3. Showing megaprosthetic reconstruction of the knee after wide resection of distal femur osteosarcoma. Cumulative Survival Survival Function Survival Function Censored Time (Months) Fig. 4. Cumulative survival graph for megaprothesis. rehabilitation with immediate full weight-bearing. Most endoprostheses are modular, thus allowing incremental prosthetic replacement in response to the length of resected bone. In addition, improvement in implant materials have greatly increased the durability of modern endoprostheses. They are able to achieve their primary aim of providing long-term function for some patients with relatively low physical demands. Mega-endoprostheses have known complications. Polyethylene wear is a limiting factor for articulating surfaces, but polyethylene bearing spacers and lugs are replaceable in most prostheses. Fatigue fracture is common at the yoke of a rotating hinge. However, fatigue fracture at the base of the intramedullary stem where it attaches to the body of the prosthesis is more problematic as extraction of the remaining stem can be very difficult. Oncological reconstruction may appear to have higher complication rates compared with standard total joint arthroplasty due to the extensive nature of the operation, extensive tissue loss, and the compromising effects of associated radiotherapy and chemotherapy (Figs. 1 to 3). In addition, reconstructions are often done in younger patients who are relatively more active, thus incurring a higher rate of wear. Our study of the 19 patients who had primary bone tumours with mega-endoprosthetic reconstruction revealed a mean MSTS functional score of 78.3%. This result is comparable with those in other studies, such as in the study by Schindler et al, in which the mean MSTS functional score was 77% in 12 patients with Stanmore custom-made extendable distal femoral prostheses. 6 We note that this study involved extendable implants (Table 4). Wilkins and Miller 7 found the mean functional scores of 73% in 26 patients with primary limb-preservation surgery with reoperations and 79% in 10 patients without re-operations. In this study, the outcome was better for those patients without re-operations. We had achieved a grading of good to excellent results in terms of mean functional score. Infection was the most common complication, with 3 patients (15.8%) having early infection and 3 patients (15.8%) having late infections, out of the 19 patients (Table 5). The rate of infection in the literature has ranged from 4% (1 out of 24 patients) in the study by Cool et al 8 to 2 out of 5 patients in the study by Schiller et al. 9 We note that these 2 studies were for extendable prostheses which have a known higher rate of infection. Comparable results have been reported by other investigators. 10,11 In our study, 1 patient required surgical debridement and revision of implant. The rest had their infection treated successfully with intravenous antibiotics and dressings. Of significance, none of the patients in our study had implant breakage, loosening or periprosthetic fracture. All the patients in our study were able to walk with or without amubulatory aids after surgical reconstruction. The limitations of this study are the small number of patients, March 2009, Vol. 38 No. 3
5 196 and its retrospective nature. Thus, tumour-related factors, adjuvant therapeutic treatments or other unexplored factors might have biased the decision with regard to the type of surgery performed. In our study, we included both benign and malignant bone diseases. We acknowledge that their outcomes will be very different, for example, in a patient with osteosarcoma who would have a very different prognosis compared with one with a benign disease such as aneurysmal bone cyst. Conclusion Mega-endoprosthetic reconstruction provides good functional outcome in patients after bone tumour re-section. They provide yet another treatment option in limb salvage. These patients have been evaluated and seem to have acceptable functional outcomes in our institution. Infection, though, remains a common complication in our study. REFERENCES 1. Harington KD, Sim FH, Enis JE, Johnston JO, Dick HM, Gristina AG. Methylmethacrylate as an adjunct in internal fixation of pathological fractures: experience with three hundred and seventy-five cases. J Bone Joint Surg 1976;58A: Sim FH, Dougherty TW, Ivins JC. The adjunctive use of methylmethacrylate in fixation of pathological fractures. J Bone Joint Surg 1974;56A: Moore A T, Bohlman HR. Metal hip joint: a case report. J Bone Joint Surg 1943;25: Sweetnam R. Limb preservation in the treatment of bone tumours. Ann R Coll Surg Engl 1983;65: Sim FH, Ivins Je, Pritchard DJ. Surgical treatment of osteogenic sarcoma at the Mayo clinic. Cancer Treat Rep 1978;62: Schindler OS, Cannon SR, Briggs TW, Blunn Gw. Stanmore custommade extendible distal femoral replacements. J Bone Joint Surg Br 1997;79: Wilkins RM, Miller CM. Reoperation after limb preservation surgery for sarcomas of the knee in children. Clin Orthop 2003;412: Cool WP, Carter SR, Grimer RJ, Tillman RM, Wal.ker PS. Growth after extendable endoprosthetic replacement of the distal femur. J Bone Joint Surg Br 1997;79: Schiller C, Windhager R, Fellinger EJ, Salzer-Kuntschik M, Kalder A, Kotz R. Extendable tumour endoprostheses for the leg in children. J Bone Joint Surg Br 1995;77: Cara JA, Canadell J. Limb salvage for malignant bone tumors in young children. J Pediatr Orthop 1994;14: Almon BA, De Bari A, Krajblch JI. Massive allografts in the treatment of osteosarcoma and Ewing sarcoma in children and adolescents. J Bone Joint Surg Am 1995;77: Hiroyuki F, Takeshi M. Long term follow-up after limb salvage in skeletally immature children with a primary malignant tumour of the distal end of the femur. J Bone Joint Surgery Am 2006;88:
Clinical Study Distal Femur Allograft Prosthetic Composite Reconstruction for Short Proximal Femur Segments following Tumor Resection
Advances in Orthopedics Volume 2013, Article ID 397456, 5 pages http://dx.doi.org/10.1155/2013/397456 Clinical Study Distal Femur Allograft Prosthetic Composite Reconstruction for Short Proximal Femur
More informationClinical Study The Use of Massive Endoprostheses for the Treatment of Bone Metastases
Hindawi Publishing Corporation Sarcoma Volume 2007, Article ID 62151, 5 pages doi:10.1155/2007/62151 Clinical Study The Use of Massive Endoprostheses for the Treatment of Bone Metastases D. H. Park, P.
More informationMethods Used for Reconstruction in Aggressive Bone Tumours: An Early Experience
ORIGINAL ARTICLE Methods Used for Reconstruction in Aggressive Bone Tumours: An Early Experience K L Pan, FRCS*, S STing, FRCS**, A W K Mohamad, MS (Orth)*, W GLee, FRCS**, C C Wong, FRCS**, A H Rasit,
More informationObjectives. Limb salvage surgery. Age distribution bone cancer. Age distribution soft tissue sarcomas
LifeSource October, 2011 Disclosure Information Putting humpty dumpty back together again is easier with tissue allografts! Limb Salvage Surgery for Bone Tumors Edward Cheng, MD October 6, 2011 Disclosure
More informationMetastatic Disease of the Proximal Femur
CASE REPORT Metastatic Disease of the Proximal Femur WI Faisham, M.Med{Ortho)*, W Zulmi, M.S{Ortho)*, B M Biswal, MBBS** 'Department of Orthopaedic, "Department of Oncology and Radiotherapy, School of
More informationLaura M. Fayad, MD. Associate Professor of Radiology, Orthopaedic Surgery & Oncology The Johns Hopkins University
Society of Pediatric Radiology, May 2013 Laura M. Fayad, MD Associate Professor of Radiology, Orthopaedic Surgery & Oncology The Johns Hopkins University Describes surgical techniques that resect and reconstruct
More informationThe results of total humeral replacement following excision for primary bone tumour
ONCOLOGY The results of total humeral replacement following excision for primary bone tumour A. Puri, A. Gulia From Tata Memorial Hospital, Mumbai, India Rarely, the extent of a malignant bone tumour may
More informationNorth of England Bone and Soft Tissue Tumour Service
North of England Bone and Soft Tissue Tumour Service Guidelines for rehabilitation after proximal tibial replacement Proximal tibial replacement surgery is usually carried out as part of treatment for
More informationSurvival of Modern Knee Megaprosthesis USA/Canada
Survival of Modern Knee Megaprosthesis USA/Canada Arthroplasty Disaster Conference Miami September 2016 Anna A. Kulidjian MD, MSc, FRCSC Chief, MSK Oncology & Joint Reconstruction UC San Diego Health Moores
More informationIntercalary Femur and Tibia Segmental Allografts Provide an Acceptable Alternative in Reconstructing Tumor Resections
CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Number 426, pp. 97 102 2004 Lippincott Williams & Wilkins Intercalary Femur and Tibia Segmental Allografts Provide an Acceptable Alternative in Reconstructing
More informationComplications of limb salvage surgery in childhood tumors and recommended solutions
Strat Traum Limb Recon (2010) 5:11 15 DOI 10.1007/s11751-009-0075-y REVIEW Complications of limb salvage surgery in childhood tumors and recommended solutions H. Ozger M. Bulbul L. Eralp Received: 19 January
More informationLarge Volume Osteosarcomas of the Femur Treated with Total Femoral Replacement
Doi: http://dx.doi.org/10.5704/moj.1403.015 Large Volume Osteosarcomas of the Femur Treated with Total Femoral Replacement Pan KL, FRCS, Chan WH, MS Orth, Shanmugam P, MD, Ong GB*, MRCP, Kamaruddin F**,
More informationThe early results of joint-sparing proximal tibial replacement for primary bone tumours, using extracortical plate fixation
The early results of joint-sparing proximal tibial replacement for primary bone tumours, using extracortical plate fixation B. G. I. Spiegelberg, M. D. Sewell, W. J. S. Aston, G. W. Blunn, R. Pollock,
More informationCase Report StructuralFailureofaModernKneeTumorMegaendoprosthesis
Hindawi Case Reports in Orthopedics Volume 2017, Article ID 2429459, 4 pages https://doi.org/10.1155/2017/2429459 Case Report StructuralFailureofaModernKneeTumorMegaendoprosthesis Katrin Koch, 1 Dieter
More informationBONE TRANSPLANTATION IN LIMB SAVING SURGERIES: THE PHILIPPINE EXPERIENCE
BONE TRANSPLANTATION IN LIMB SAVING SURGERIES: THE PHILIPPINE EXPERIENCE EDWARD HM WANG, MD UP-Musculoskeletal Tumor Unit and Tissue & Bone Bank Dept. of Orthopedics University of the Philippines-Philippine
More informationLimb Salvage Surgery for Musculoskeletal Oncology
Editorial Limb Salvage Surgery for Musculoskeletal Oncology Wan Faisham Nu man Bin Wan Ismail Submitted: 2 May 2015 Accepted: 18 June 2015 Orthopaedic Oncology Unit, Orthopaedic Department, School of Medical
More informationNorth of England Bone and Soft Tissue Tumour Service
North of England Bone and Soft Tissue Tumour Service Guidelines for rehabilitation after replacement of the proximal femur Proximal femoral replacement surgery is usually carried out as part of treatment
More informationLooking for the limit of limb sparing in pelvic bone sarcomas Isidro Gracia Hospital de la Santa Creu i Sant Pau, Barcelona
Unidad de Cirugía Ortopédica Oncológica. Servicio COT Unidad Funcional de Tumores Mesenquimales Hospital de la Santa Creu i Sant Pau Barcelona Looking for the limit of limb sparing in pelvic bone sarcomas
More informationGrowth in the lower lim b following chem otherapy for a malignant prim ary bone tumour: a straight-line graph
Sarcoma (1997) 1, 75± 77 O RIGINAL ARTIC LE Growth in the lower lim b following chem otherapy for a malignant prim ary bone tumour: a straight-line graph PAUL COOL, M ARK D AVIES, ROB J. GRIM ER, SIM ON
More informationCase Report Total femur replacement: a limb-saving strategy for patients with primary malignant femoral tumors
Int J Clin Exp Med 2018;11(5):5186-5192 www.ijcem.com /ISSN:1940-5901/IJCEM0067064 Case Report Total femur replacement: a limb-saving strategy for patients with primary malignant femoral tumors Shengjun
More informationReconstruction of Lower Extremity Primary Malignant and Metastatic Bone Tumours with Modular Endoprosthesis
Original Article Reconstruction of Lower Extremity Primary Malignant and Metastatic Bone Tumours with Modular Endoprosthesis H Sezgin, A Çıraklı 1, H Göçer 2, N Dabak 2 Department of Orthopedic and Traumatology,
More informationChondroblastoma of bone
Chronology Chondroblastoma of bone LONG-TERM RESULTS AND FUNCTIONAL OUTCOME AFTER INTRALESIONAL CURETTAGE R. Suneja, R. J. Grimer, M. Belthur, L. Jeys, S. R. Carter, R. M. Tillman, A. M. Davies From The
More informationLongitudinal growth following treatm ent for osteosarcom a
1357-714 X/98/020115± 05 Ó 1998 Carfax Publishing Ltd Sarcoma (1998) 2, 115± 119 O RIGINAL ARTIC LE Longitudinal growth following treatm ent for osteosarcom a W. PAUL COOL, ROBERT J. GRIM ER, SIMON R.
More informationSalvage of infected proximal tibial tumour prosthesis using vacuum assisted closure in seven patients
International Journal of Research in Orthopaedics Balasubramanian N et al. Int J Res Orthop. 2017 Mar;3(2):172-176 http://www.ijoro.org Original Research Article DOI: http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20170434
More informationSYMPOSIUM: 2015 MEETINGS OF THE MUSCULOSKELETAL TUMOR SOCIETY AND THE
Clin Orthop Relat Res (2017) 475:676 682 DOI 10.1007/s11999-016-4843-y Clinical Orthopaedics and Related Research A Publication of The Association of Bone and Joint Surgeons SYMPOSIUM: 2015 MEETINGS OF
More informationRotationplasty for limb salvage C Figure 1. Case 1. () Preoperative roentgenogram of the femurs showing the destructive lesion with mothy geographic p
H.C. Wang, Y.M. Lu, S.H. Chien, et al ROTTIONPLSTY FOR LIM SLVGE IN THE TRETMENT OF MLIGNNT TUMORS: REPORT OF TWO CSES Hsien-Chung Wang, Yen-Mou Lu, Song-Hsiung Chien, Gau-Tyan Lin, and Cheng-Chang Lu
More informationTitle: An intramedullary free vascularized fibular graft combined with pasteurized
Title: An intramedullary free vascularized fibular graft combined with pasteurized autologous bone graft in leg reconstruction for patients with osteosarcoma Names of authors Masataka Noguchi, Hiroo Mizobuchi,
More informationUse Of A Long Femoral Stem In The Treatment Of Proximal Femoral Fractures: A Report Of Four Cases
ISPUB.COM The Internet Journal of Orthopedic Surgery Volume 5 Number 1 Use Of A Long Femoral Stem In The Treatment Of Proximal Femoral Fractures: A Report Of Four Cases C Yu, V Singh Citation C Yu, V Singh..
More informationManagement of infected custom mega prosthesis by Ilizarov method
International Journal of Research in Medical Sciences Gudaru K et al. Int J Res Med Sci. 2015 Dec;3(12):3874-3878 www.msjonline.org pissn 2320-6071 eissn 2320-6012 Case Report DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20151459
More informationPersistent Wound Drainage After Tumor Resection and Endoprosthetic Reconstruction of the Proximal Femur
Send Orders for Reprints to reprints@benthamscience.ae The Open Orthopaedics Journal, 4, 8, 475-48 475 Open Access Persistent Wound Drainage After Tumor Resection and Endoprosthetic Reconstruction of the
More informationFor Commercial products, please refer to the following policy: Preauthorization via Web-Based Tool for Procedures
Medical Coverage Policy Total Joint Arthroplasty Hip and Knee EFFECTIVE DATE: 08/01/2017 POLICY LAST UPDATED: 06/06/2017 OVERVIEW Joint replacement surgery, also known as arthroplasty, has proved to be
More informationGiant cell tumour of the proximal femur
ONCOLOGY Giant cell tumour of the proximal femur IS JOINT-SPARING MANAGEMENT EVER SUCCESSFUL? A. E. Wijsbek, B. L. Vazquez- Garcia, R. J. Grimer, S. R. Carter, A. A. Abudu, R. M. Tillman, L. Jeys From
More informationKnee Revision. Portfolio
Knee Revision Portfolio I use the DePuy Revision Knee System because of its versatility. With this system I can solve nearly any situation I encounter in the OR. Dr. Thomas Fehring, OrthoCarolina Hip and
More informationClinical Study Primary Malignant Tumours of Bone Following Previous Malignancy
Sarcoma Volume 2008, Article ID 418697, 4 pages doi:10.1155/2008/418697 Clinical Study Primary Malignant Tumours of Bone Following Previous Malignancy J. T. Patton, S. M. M. Sommerville, and R. J. Grimer
More informationOriginal Date: December 2015 Page 1 of 8 FOR CMS (MEDICARE) MEMBERS ONLY
National Imaging Associates, Inc. Clinical guidelines TOTAL JOINT ARTHROPLASTY -Total Hip Arthroplasty -Total Knee Arthroplasty -Replacement/Revision Hip or Knee Arthroplasty CPT4 Codes: Please refer to
More informationManagement of Campanacci type III giant cell tumor
2017; 3(1): 836-841 ISSN: 2395-1958 IJOS 2017; 3(1): 836-841 2017 IJOS www.orthopaper.com Received: 15-11-2016 Accepted: 16-12-2016 Brig. Muhammad Suhail Amin Head of Orthopedics Surgery Department, Combined
More informationIndex. orthopedic.theclinics.com. Note: Page numbers of article titles are in boldface type.
Note: Page numbers of article titles are in boldface type. A Acetabular fractures pediatric, 494 498 classification of, 494 diagnostic imaging of, 494, 496 497 epidemiology of, 494 treatment of, 494 498
More informationPublications, Presentations & Invited lectures
Publications, Presentations & Invited lectures Mr Manoj K Sood BSc.(Hons) MB.BS. FRCS (Eng.) FRCS (Tr. & Orth.) Consultant Orthopaedic Surgeon Hip, Knee & Sports Specialist PAPERS PUBLISHED Should primary
More informationSurgical management of Grade I chondrosarcoma of the long bones
Acta Orthop. Belg., 2013, 79, 331-337 ORIGINAL STUDY Surgical management of Grade I chondrosarcoma of the long bones Cuneyd Gunay, Hakan Atalar, Onur Hapa, Kerem Basarir, Yusuf Yildiz, Yener Saglik From
More informationSURGICAL MANAGEMENT OF OSTEOGENIC SARCOMA OF THE LOWER LIMB JOSEPH M. LANE, M.D., GERALD ROSEN, M.D.,
395 SURGICAL MANAGEMENT OF OSTEOGENIC SARCOMA OF THE LOWER LIMB JOSEPH M. LANE, M.D., GERALD ROSEN, M.D., PATRICK BOLAND, M.D., JAMES OTIS, PH.D., AND KAMEL ABOU ZAHR, M.D. Memorial Sloan-Kettering Cancer
More informationClinical Study Metastasectomy of Pulmonary Metastases from Osteosarcoma: Prognostic Factors and Indication for Repeat Metastasectomy
Respiratory Medicine Volume 2015, Article ID 570314, 5 pages http://dx.doi.org/10.1155/2015/570314 Clinical Study Metastasectomy of Pulmonary Metastases from Osteosarcoma: Prognostic Factors and Indication
More informationResult of extracorporeal irradiation and re-implantation for malignant bone tumors: A review of 30 patients
bs_bs_banner Asia-Pacific Journal of Clinical Oncology 2012 doi: 10.1111/ajco.12036 ORIGINAL ARTICLE Result of extracorporeal irradiation and re-implantation for malignant bone tumors: A review of 30 patients
More informationJMSCR Vol 06 Issue 12 Page December 2018
www.jmscr.igmpublication.org Impact Factor (SJIF): 6.379 Index Copernicus Value: 79.54 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v6i12.140 A Case Report of Recurrent
More informationComputer aided analysis of total knee replacement
Annals of the Rheumatic Diseases, 1983, 42, 415-420 Computer aided analysis of total knee replacement in rheumatoid arthritis G. P. ARDEN From the Windsor Group of Hospitals SUMMARY A computer-aided analysis
More informationOver a 25-year period we have treated 36 patients
Osteosarcoma of the pelvis R. J. Grimer, S. R. Carter, R. M. Tillman, D. Spooner, D. C. Mangham, Y. Kabukcuoglu From the Royal Orthopaedic Hospital Oncology Service, Birmingham, England Over a 25-year
More informationKnee Replacement Complications
Knee Replacement Complications Knee replacements have become a routine surgery in the United States. Nearly 700,000 people each year receive this life-improving surgery and are able to enjoy richer, more
More informationManagement of periprosthetic fractures in patients treated with a megaprosthesis for malignant bone tumours around the knee
Acta Orthop. Belg., 2012, 78, 558-563 CASE REPORT Management of periprosthetic fractures in patients treated with a megaprosthesis for malignant bone tumours around the knee Michael GEBHARt, Félix SHuMElInSky
More informationDistal femoral reconstruction following failed total knee arthroplasty is accompanied with risk for complication and reduced joint function
Vertesich et al. BMC Musculoskeletal Disorders (2019) 20:47 https://doi.org/10.1186/s12891-019-2432-4 RESEARCH ARTICLE Distal femoral reconstruction following failed total knee arthroplasty is accompanied
More informationCLINICAL AND OPERATIVE APPROACH FOR TOTAL KNEE REPLACEMENT DR.VINMAIE ORTHOPAEDICS PG 2 ND YEAR
CLINICAL AND OPERATIVE APPROACH FOR TOTAL KNEE REPLACEMENT DR.VINMAIE ORTHOPAEDICS PG 2 ND YEAR Evolution of TKR In 1860, Verneuil proposed interposition arthroplasty, involving the insertion of soft tissue
More informationZimmer Segmental System
Zimmer Segmental System Simple solutions for solving complex salvage cases A Step Forward The Zimmer Segmental System is designed to address patients with severe bone loss associated with disease, trauma
More informationClinical Study Comparison between Constrained and Semiconstrained Knee Allograft-Prosthesis Composite Reconstructions
Sarcoma Volume 2013, Article ID 489652, 8 pages http://dx.doi.org/10.1155/2013/489652 Clinical Study Comparison between Constrained and Semiconstrained Knee Allograft-Prosthesis Composite Reconstructions
More informationResults of thoracotomy in osteogenic sarcoma
Thorax 1991;46:727-731 Bone Tumour Treatment Service, Royal Orthopaedic Hospital, Birmingham B31 2AP S R Carter R J Grimer R S Sneath Thoracic Surgery Unit, East Birmingham Hospital, Birmingham B9 SST
More informationSTANMORE CUSTOM-MADE EXTENDIBLE DISTAL FEMORAL REPLACEMENTS
STANMORE CUSTOM-MADE EXTENDIBLE DISTAL FEMORAL REPLACEMENTS CLINICAL EXPERIENCE IN CHILDREN WITH PRIMARY MALIGNANT BONE TUMOURS OLIVER S. SCHINDLER, STEPHEN R. CANNON, TIMOTHY W. R. BRIGGS, GORDON W. BLUNN
More informationWe studied the CT and MR scans, and the
Tumour volume as a predictor of necrosis after chemotherapy in Ewing s sarcoma A. Abudu, A. M. Davies, P. B. Pynsent, D. C. Mangham, R. M. Tillman, S. R. Carter, R. J. Grimer From the Royal Orthopaedic
More informationLimb Salvage in Bone Sarcomas in Patients Younger Than Age 10. A 20-Year Experience.
Limb Salvage in Bone Sarcomas in Patients Younger Than Age 10. A 20-Year Experience. Mikel San-Julian, MD, PhD, Rodrigo Dölz, MD, Elena Garcia-Barrecheguren, MD, Eneko Noain, MD, Luis Sierrasesumaga, MD,
More informationInformed Consent for HRA
Updated March 09 Thomas P Gross MD Informed Consent for HRA Dr. Gross has now performed over 5500 Hip Resurfacing Arthroplasty (HRA) procedures over the last 8 years. Most failures occur during the first
More informationEndoprosthetic treatment of primary bone sarcomas with pathological fractures
SA Orthopaedic Journal Winter 2016 Vol 15 No 2 Page 43 Endoprosthetic treatment of primary bone sarcomas with pathological fractures Dr Thomas L Hilton MBChB(UCT), DA(SA), DipPEC(SA), FCS(Orth), MMed(UCT)
More informationBilateral total knee arthroplasty: One mobile-bearing and one fixed-bearing
Journal of Orthopaedic Surgery 2001, 9(1): 45 50 Bilateral total knee arthroplasty: One mobile-bearing and one fixed-bearing KY Chiu, TP Ng, WM Tang and P Lam Department of Orthopaedic Surgery, The University
More informationClassification of failure of limb salvage after reconstructive surgery for bone tumours
SPECIALTY UPDATE: ONCOLOGY Classification of failure of limb salvage after reconstructive surgery for bone tumours A MODIFIED SYSTEM INCLUDING BIOLOGICAL AND EXPANDABLE RECONSTRUCTIONS E. R. Henderson,
More informationJ of Evolution of Med and Dent Sci/ eissn , pissn / Vol. 4/ Issue 22/ Mar 16, 2015 Page 3785
COMPARATIVE STUDY OF FRACTURE NECK OF FEMUR TREATED WITH UNIPOLAR AND BIPOLAR HEMIARTHROPLASTY V. Nava Krishna Prasad 1, B. Mohammed Ghouse 2, B. Jaya Chandra Reddy 3, L. Abhishek 4 HOW TO CITE THIS ARTICLE:
More informationDoes the self-centering mechanism of bipolar hip endoprosthesis really work in vivo?
Journal of Orthopaedic Surgery 2005;13(1):46-51 Does the self-centering mechanism of bipolar hip endoprosthesis really work in vivo? H Tsumura, N Kaku, T Torisu Department of Orthopedic Surgery, Oita University,
More informationOverview of Endoprosthetic. reconstruction. Chapter 3 BACKGROUND. Martin M. Malawer, Robert M. Henshaw, and Kristen Kellar-Graney
13282_ON-3.qxd 5/12/09 12:01 PM Page 1 Chapter 3 Overview of Endoprosthetic Reconstruction Martin M. Malawer, Robert M. Henshaw, and Kristen Kellar-Graney CKGROUND Limb salvage reconstruction following
More informationSymptoms and signs associated with benign and malignant proximal fibular tumors: a clinicopathological analysis of 52 cases
Sun et al. World Journal of Surgical Oncology (2017) 15:92 DOI 10.1186/s12957-017-1162-z RESEARCH Open Access Symptoms and signs associated with benign and malignant proximal fibular tumors: a clinicopathological
More informationPart Two: Hip Resurfacing vs Conventional Total Hip Replacement
Part Two: Hip Resurfacing vs Conventional Total Hip Replacement Mr. Mark Bloomfield Consultant Orthopaedic Surgeon Harley St Clinic, London Princess Margaret Hospital, Windsor Save the femoral head! Conventional
More informationCase Study: David. Conditions Treated Femoral Neck Fracture with Avascular Necrosis of the Hip. Age Range During Treatment 16 Years
Case Study: David Conditions Treated Femoral Neck Fracture with Avascular Necrosis of the Hip Age Range During Treatment 16 Years David S. Feldman, MD Chief of Pediatric Orthopedic Surgery Professor of
More informationOsteosarcoma Around the Knee Treated With Neoadjuvant Chemotherapy and a Custom-designed Prosthesis
Osteosarcoma Around the Knee Treated With Neoadjuvant Chemotherapy and a Custom-designed Prosthesis Wenzhi Bi, PhD; Wei Wang, MD; Gang Han, PhD; Jinpeng Jia, PhD; Meng Xu, MD abstract Full article available
More informationMicrowave ablation of malignant extremity bone tumors
DOI 10.1186/s40064-016-3005-8 RESEARCH Open Access Microwave ablation of malignant extremity bone tumors Qing Yu Fan *, Yong Zhou, Minghua Zhang, Baoan Ma, Tongtao Yang, Hua Long, Zhe Yu and Zhao Li Abstract
More informationCIRCUMFERENTIAL PROXIMAL FEMORAL ALLOGRAFTS IN REVISION SURGERY ON TOTAL HIP ARTHROPLASTY: CASE REPORTS WITH A MINIMUM FOLLOW-UP OF 20 YEARS
CASE REPORT CIRCUMFERENTIAL PROXIMAL FEMORAL ALLOGRAFTS IN REVISION SURGERY ON TOTAL HIP ARTHROPLASTY: CASE REPORTS WITH A MINIMUM FOLLOW-UP OF 20 YEARS Bruno Dutra Roos 1, Milton Valdomiro Roos 2, Antero
More informationResection Arthrodesis of the Knee for Osteosarcoma: An Alternative When Mobile Joint Reconstruction Is Not Feasible
Original Article 411 Resection Arthrodesis of the Knee for Osteosarcoma: An Alternative When Mobile Joint Reconstruction Is Not Feasible Hsin-Nung Shih, MD; Lih-Yuann Shih, MD Results: Background: Wide
More informationAssociated Terms: Osteosarcoma, Bone Cancer, Limb Salvage, Appendicular Osteosarcoma, Pathologic Fracture, Chondrosarcoma
1 of 9 9/29/2014 8:25 PM Associated Terms: Osteosarcoma, Bone Cancer, Limb Salvage, Appendicular Osteosarcoma, Pathologic Fracture, Chondrosarcoma The term "ACVS Diplomate" refers to a veterinarian who
More informationThe most common pediatric bone cancer is osteogenic. Repiphysis Prosthesis for Limb Preservation in Pediatric Patients With Bone Cancer
Repiphysis Prosthesis for Limb Preservation in Pediatric Patients With Bone Cancer A Literature Review Kimberly Haynes Carrie Tyner Phoebe D. Williams Osteosarcoma is the most common bone sarcoma in children
More informationFibula bone grafting in infected gap non union: A prospective case series
2019; 3(1): 06-10 ISSN (P): 2521-3466 ISSN (E): 2521-3474 Clinical Orthopaedics www.orthoresearchjournal.com 2019; 3(1): 06-10 Received: 03-11-2018 Accepted: 06-12-2018 Dr. Mohammed Nazim M.S (Ortho),
More informationSynthetic Mesh Improves Shoulder Function After Intraarticular Resection and Prosthetic Replacement of Proximal Humerus
Clin Orthop Relat Res (2015) 473:1464 1471 DOI 10.1007/s11999-015-4139-7 Clinical Orthopaedics and Related Research A Publication of The Association of Bone and Joint Surgeons CLINICAL RESEARCH Synthetic
More informationAOANJRR Automated Industry Report Depuy Synthes Australia Attune PS Total Knee Data Period: 1 September August 2018
AOANJRR Automated Industry Report 335 - Depuy Synthes Australia Total Knee Catalogue Numbers of Femoral Components included in this analysis Model Catalogue Range Range Description No. of Primary Procedures
More informationChondrosarcoma with a late local relapse
Chondrosarcoma with a late local relapse J. Shinoda, T. Ozaki, T. Oka, T. Kunisada, H. Inoue Department of Orthopaedic Surgery, Okayama University Medical School, Okayama, 700-8558, Japan Correspondence:
More informationAutomated Industry Report 824 Depuy Synthes Australia Attune PS Total Knee
Automated Industry Report 824 Depuy Synthes Australia Total Knee Report Generated: 9 January 2019 This report has been prepared by the Australian Orthopaedic Association National Joint Replacement Registry
More informationREPIPHYSIS LIMB SALVAGE SYSTEM
REPIPHYSIS LIMB SALVAGE SYSTEM 150800-0 For additional information please contact the manufacturer or local distributor. M MicroPort Orthopedics Inc. 5677 Airline Rd Arlington, TN 38002 U.S.A. i Y October
More informationCustom Total Femur Spacer and Second-Stage Total Femur Arthroplasty as a Novel Approach to Infection and Periprosthetic Fracture
The Journal of Arthroplasty Vol. 23 No. 5 2008 Case Report Custom Total Femur Spacer and Second-Stage Total Femur Arthroplasty as a Novel Approach to Infection and Periprosthetic Fracture Seth L. Sherman,
More informationILIZAROV TECHNIQUE IN CORRECTING LIMBS DEFORMITIES: PRELIMINARY RESULTS
Bahrain Medical Bulletin, Volume 17, Number 2, June 1995 Original ILIZAROV TECHNIQUE IN CORRECTING LIMBS DEFORMITIES: PRELIMINARY RESULTS Saleh W. Al-Harby, FRCS(Glasg)* This is a prospective study of
More informationPeriosteal osteosarcoma: a review of 17 cases with mean follow-up of 52 months
Sarcoma (2002) 6, 23 30 REVIEW Periosteal osteosarcoma: a review of 7 cases with mean follow-up of 52 months MATTHEW P. REVELL, NEETA DESHMUKH, ROBERT J. GRIMER, SIMON R. CARTER & ROGER M.TILLMAN The Royal
More informationUncemented, curved, short endoprosthesis stem for distal femoral reconstruction: early follow-up outcomes
Lu et al. World Journal of Surgical Oncology (2018) 16:183 https://doi.org/10.1186/s12957-018-1486-3 RESEARCH Open Access Uncemented, curved, short endoprosthesis stem for distal femoral reconstruction:
More informationOutcome of Pathologic Fractures of the Proximal Femur in Non osteogenic Primary Bone Sarcoma
Outcome of Pathologic Fractures of the Proximal Femur in Non osteogenic Primary Bone Sarcoma Coonoor R. Chandrasekar, Robert J. Grimer, Simon R. Carter, Roger M. Tillman, Adesegun T. Abudu, Lee M. Jays
More informationOsteoarthrosis, unspecified whether generalized or localized, lower leg. Osteoarthrosis, localized, not specified whether primary or secondary, pelvic
Page 1 Appendix TABLE E-1 Codes (and Definitions) in Humana Database Used for Study Inclusion and Exclusion of Patients Who Underwent,, or 1 to 2-Level Inclusion ICD-9-P-8154 Total knee replacement ICD-9-D-71596
More informationCEC ARTICLE: Special Medical Conditions Part 3: Hip and Knee Replacement C. Eggers
CEC ARTICLE: Special Medical Conditions Part 3: Hip and Knee Replacement C. Eggers Joint replacement surgery removes a damaged joint and replaces it with a prosthesis or artificial joint. The purpose of
More informationModified Harrington Procedure for Acetabular Insuficiency Due to Metastatic Malignant Disease
Malaysian Orthopaedic Journal 2009 Vol 3 No 1 WI Faisham, et al Modified Harrington Procedure for Acetabular Insuficiency Due to Metastatic Malignant Disease WI Faisham, MMed Ortho, DAJ Muslim, MRCS, VMK
More informationCAUTION Federal law (USA) restricts this device to sale, by or on the order of a physician.
CAUTION Federal law (USA) restricts this device to sale, by or on the order of a physician. ENGLISH Mpact 3D Metal Implants and Augments 3D Metal INSTRUCTION FOR USE Important notice: the device(s) can
More informationJMSCR Vol. 03 Issue 07 Page July 2015
www.jmscr.igmpublication.org Impact Factor 3.79 ISSN (e)-2347-176x Results of Resection of Tumors around Knee with Reconstruction Using Arthrodesis or Endoprosthetic Reconstruction Authors Dr. K. Nageshwar
More informationCase Report Leg Lengthening as a Means of Improving Ambulation Following an Internal Hemipelvectomy
Case Reports in Orthopedics Volume 2016, Article ID 7089142, 4 pages http://dx.doi.org/10.1155/2016/7089142 Case Report Leg Lengthening as a Means of Improving Ambulation Following an Internal Hemipelvectomy
More informationOncological and functional results after surgical treatment of bone metastases at the proximal femur
Guzik BMC Surgery (2018) 18:5 DOI 10.1186/s12893-018-0336-0 RESEARCH ARTICLE Open Access Oncological and functional results after surgical treatment of bone metastases at the proximal femur Grzegorz Guzik
More informationOutcome of Girdlestone s resection arthroplasty following complications of proximal femoral fractures
Acta Orthop. Belg., 2006, 72, 555-559 ORIGINAL STUDY Outcome of Girdlestone s resection arthroplasty following complications of proximal femoral fractures Himanshu SHARMA, Rahul KAKAR From the Royal Alexandra
More informationLimb salvage surgery in bone tumour with modular endoprosthesis
International Orthopaedics (SICOT) (1999) 23:41 46 Springer-Verlag 1999 ORIGINAL PAPER selor&:b.k.s. Sanjay P.G. Moreau Limb salvage surgery in bone tumour with modular endoprosthesis csim&:accepted: 8
More informationClinical Study Pathological Fracture of the Proximal Femur in Osteosarcoma: Need for Early Radical Surgery?
International Scholarly Research Network ISRN Oncology Volume 202, Article ID 52389, 6 pages doi:0.5402/202/52389 Clinical Study Pathological Fracture of the Proximal Femur in Osteosarcoma: Need for Early
More informationImaging of Complications After Limb Prostheses Implantation in Children with Bone Tumors
Signature: Pol J Radiol, 2017; 82: 227-232 DOI: 10.12659/PJR.900644 ORIGINAL ARTICLE Received: 2016.07.17 Accepted: 2016.08.12 Published: 2017.04.22 Authors Contribution: A Study Design B Data Collection
More informationThe Scandinavian Sarcoma Group skeletal metastasis register: Survival after surgery for bone metastases in the pelvis and extremities
The Scandinavian Sarcoma Group skeletal metastasis register: Survival after surgery for bone metastases in the pelvis and extremities Hansen, B. H.; Keller, J.; Laitinen, M.; Berg, P.; Skjeldal, S.; Trovik,
More informationFemoral neck fracture during physical therapy following surface replacement arthroplasty: a preventable complication?
CASE REPORT Open Access Femoral neck fracture during physical therapy following surface replacement arthroplasty: a preventable complication? A case report Timothy R Judkins, Michael R Dayton * Abstract
More informationNursing Management: Musculoskeletal Trauma and Orthopedic Surgery. By: Aun Lauriz E. Macuja SAC_SN4
Nursing Management: Musculoskeletal Trauma and Orthopedic Surgery By: Aun Lauriz E. Macuja SAC_SN4 The most common cause of musculoskeletal injuries is a traumatic event resulting in fracture, dislocation,
More informationMalaysian Orthopaedic Journal 2018 Vol 12 No 3
doi: http://dx.doi.org/10.5704/moj.1811.004 Functional Outcome after Treatment of Aggressive Tumours in the Distal Radius: Comparison between Reconstruction using Proximal Fibular Graft and Wrist Fusion
More informationAutomated Industry Report 823 Depuy Synthes Australia Attune CR Total Knee
Automated Industry Report 823 Depuy Synthes Australia Total Knee Report Generated: 9 January 2019 This report has been prepared by the Australian Orthopaedic Association National Joint Replacement Registry
More informationEffects of metaphyseal bone tumor removal with preservation of the epiphysis and knee arthroplasty
EXPERIMENTAL AND THERAPEUTIC MEDICINE 8: 567-572, 2014 Effects of metaphyseal bone tumor removal with preservation of the epiphysis and knee arthroplasty PENG ZHANG 1, FEIFEI FENG 2, QIQING CAI 1, WEITAO
More information